Effectiveness of treatment tactics in patients with postoperative peritonitis
DOI:
https://doi.org/10.11603/2414-4533.2023.2.13995Keywords:
postoperative peritonitis, surgical treatmentAbstract
The aim of the work: to improve the effectiveness of treatment of patients with postoperative peritonitis by using effective surgical tactics with priority use of minimally invasive technologies.
Materials and Methods. 198 patients with postoperative peritonitis were treated in the surgery department of the communal non-profit enterprise Regional Clinical Hospital of the Ivano-Frankivsk Regional Council in the period from 2016 to 2021.
Results and Discussion. The method and scope of surgical intervention in patients with postoperative peritonitis was determined individually based on the results of an objective examination, clinical and laboratory data, and evaluation of the results of the applied instrumental research methods. Preference was given to minimally invasive technologies. Minimally invasive repeated surgical interventions were performed in 114 (57.6%) patients with postoperative peritonitis. Of the 114 patients who underwent minimally invasive surgical interventions, 55 (48.2 %) underwent laparoscopic sanation and drainage of the abdominal cavity abscess. At the same time, among 34 (30.9 %) patients with postoperative peritonitis with interloop abscesses, 19 (55.9%) patients underwent laparoscopic sanation and drainage of the abscess. In 8 (23.5 %) patients, surgical intervention was started with laparoscopy, however, due to technical impossibility to adequately heal and drain the abscess, was applied conversion to laparotomy. In 11 (27.9 %) patients with interloop abscesses were performed relaparotomy, sanation and drainage of the abdominal cavity. 45 out of 244 patients with postoperative peritonitis with abdominal sepsis died, postoperative mortality was 18.4 %. The use of surgical treatment in patients with postoperative peritonitis with the priority use of mini-invasive technologies using laparoscopy and percutaneous puncture-drainage interventions under ultrasound control made it possible to increase the number of mini-invasive interventions over open ones by 4.2 times, reduce the percentage of relaparotomy by 32.3 % and reduce the postoperative mortality from 31.6 % to 18.4 %.
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